Hemodynamic Disorders, Thrombosis

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Hemodynamic Disorders, Thrombosis Shock

• Edema

• Edema
• Hyperemia and Congestion
• Hemorrhage
• Hemostasis Thrombosis
• Embolism
• Infarction
• Shock

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EDEMA

• Fluid extravasations and accumulation in the
  interstitial spaces

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EDEMA

• Increased fluid in the interstitial tissue
  spaces
• Fluid may also accumulate in body cavities
• Hydrothorax
• Hydropericardium
• Hydroperitoneum is also called Ascites
• Massive generalized edema is called Anasarca

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Fluid Homeostasis

• Homeostasis is maintained by the opposing effects
  of
• Vascular Hydrostatic Pressure
• and
• Plasma Colloid Osmotic Pressure

Lymphatics
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Edema Fluid TRANSUDATE

• A transudate is protein-poor (specific gravity
  lt1.012)
• An exudate is protein-rich (specific gravity
  gt1.020) (inflammatory edema)

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Pathophysiologic Categories of Edema
I. Increased Hydrostatic Pressure

• I. Increased Hydrostatic Pressure
• II. Reduced Plasma Oncotic Pressure
• III. Inflammation
• IV. Others

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Pathophysiologic Categories of Edema

• Increased Hydrostatic Pressure
• Due to impaired venous return
• Localized
• Venous Thrombosis
• Generalized
• Congestive Heart Failure
• Due o increased arteriolar dilatation

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Increased Hydrostatic Pressure

• Congestive Heart Failure
• Generalized increase in venous pressure,
• with resultant SYSTEMIC EDEMA occurs
• MOST COMMONLY in CONGESTIVE HEART
  FAILURE
• Thus, Congestive Heart Failure is the most
  common cause of EDEMA due to Increased
  Hydrostatic Pressure

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Congestive Heart Failure

• Overall, there are TWO main effects...

1. Increased Central Venous Pressure
2. Decreased Renal Perfusion
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Increased Hydrostatic Pressure Congestive
Heart Failure

• Mechanism
• The Pump is FAILING!!! ? ? Cardiac output
• Blood backs up, first into the lungs
• ? then into the venous circulation
• ? increasing Central Venous Pressure (CVP)
• ? increased capillary pressure (Hydrostatic
  Pressure)
• Leading to Edema

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Congestive Heart Failure Decreased Renal
Perfusion

• Congestive heart failure ?
• Decreased Cardiac Output ?
• Decreased ARTERIAL blood volume ?

Less arterial bloodLess renal perfusion... The
Kidney doesnt see enough blood coming through .
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Congestive Heart Failure Decreased Renal
Perfusion

• Decreased Renal Perfusion activates
• the Renal Defense Mechanisms
• Renin-Angiotensin-Aldosterone axis ?
• ? Na H2O retention
• Renal Vasoconstriction
• Increased Renal Anti-diuretic Hormone (ADH)

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Congestive Heart Failure - Summary
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Pathophysiologic Categories of Edema

• I. Increased Hydrostatic Pressure
• II. Reduced Plasma Oncotic Pressure
• III. Inflammation
• IV. Other

II. Reduced Plasma Oncotic Pressure
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Reduced Plasma Osmotic Pressure

• Albumin
• is the serum protein MOST responsible for the
  maintenance of colloid osmotic pressure.
• A decrease in osmotic pressure can result from
• ? Protein Loss
• or
• ? Protein Synthesis

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Reduced Plasma Osmotic Pressure

• Increased albumin loss
• Nephrotic Syndrome
• Increased permeability of the glomerular
  capillary wall ? loss of protein
• Reduced albumin synthesis
• Cirrhosis
• Protein malnutrition

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Pathophysiologic Categories of Edema

• I. Increased Hydrostatic Pressure
• II. Reduced Plasma Oncotic Pressure
• III. Inflammation
• IV. Other

III. Inflammation
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Pathophysiologic Categories of Edema

• I. Increased Hydrostatic Pressure
• II. Reduced Plasma Oncotic Pressure
• III. Inflammation
• IV. Others

IV. Others - Lymphatic Obstruction - Sodium
water retention
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Lymphatic Obstruction

• Impaired lymphatic drainage with resultant
  lymphedema
• usually localized
• usually due to
• INFLAMMATION
• or
• NEOPLASTIC OBSTRUCTION

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Lymphatic Obstruction

• Filariasis
• A parasitic infection affecting inguinal
  lymphatics resulting in elephantiasis

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Lymphatic Obstruction Neoplastic

• Resection and/or radiation to axillary lymphatics
  in breast cancer patients can lead to -- arm
  edema
• Carcinoma of breast with obstruction of
  superficial lymphatics can lead to edema of
  breast skin -- --with an unusual appearance
• peau dorange (orange peel)

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EDEMA - Summary
INCREASED HYDROSTATIC PRESSURE Congestive Heart
Failure Ascites Venous Obstruction
DECREASED ONCOTIC PRESSURE Nephrotic
Syndrome Cirrhosis Protein Malnutrition

• HEART
• LIVER
• KIDNEY

LYMPHATIC OBSTRUCTION Inflammatory Neoplastic
INCREASED PERMEABILITY Inflammation
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GENERALIZED EDEMA

• HEART
• LIVER
• KIDNEY

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Edema Morphology

• Subcutaneous Edema
• Edema of the subcutaneous tissue is most easily
  detected Grossly (not microscopically)
• Push your finger into it
• and a depression remains

• Dependent Edema is a prominent feature of
  Congestive Heart Failure
• Facial Edema is often the initial manifestation
  of Nephrotic Syndrome

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Edema

• Clinical Correlation
• Subcutaneous Edema
• Annoying but Points to Underlying Disease
• However, it can impair wound healing or clearance
  of Infection

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Edema Morphology

• Pulmonary Edema
• is most frequently seen in Congestive Heart
  Failure
• May also be present in renal failure, adult
  respiratory distress syndrome (ARDS), pulmonary
  infections and hypersensitivity reactions

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Pulmonary Edema Gross

• The Lungs are typically 2-3 times the normal
  weight
• Cross sectioning causes an outpouring of frothy,
• sometimes blood-tinged fluid

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Normal
Pulmonary Edema
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Edema

• Clinical Correlation
• Pulmonary Edema
• May cause death by interfering with Oxygen and
  Carbon Dioxide exchange
• Creates a favorable environment for infection
• THINK it resembles Culture Media!!!

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Edema of the Brain

• Trauma, Abscess, Neoplasm, Infection
  (Encephalitis due to say West Nile Virus), etc

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Clinical Correlation Edema of the Brain

• The big problem is There is no place for the
  fluid to go!
• Herniation into the foramen magnum will kill